Attachment A.1 - Medical PCR (SF and ES).pdf

PDF 221 KB Posted

Attached to
Peterson and Schriever SFB Ambulance Services Federal contract opportunity
Solicitation number
FA251725R0013
Issued by
Department of the Air Force Space Command

About this file

This is a Patient Care Report (PCR) template for Schriever Fire & Emergency Services, designed to capture comprehensive medical incident documentation. The form includes sections for incident details, demographic information, medical information, vital signs, O2/Airway procedures, medication administration, and a narrative section. It provides spaces to record critical information such as call times, patient identification, medical complaints, past medical history, allergies, medications, vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation), and specific medical interventions performed during the emergency response. The template is structured to ensure thorough documentation of emergency medical service encounters, with designated areas for EMT/EMR technician and reviewer signatures.

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Text version

SCHRIEVER F&ES PCR

Date: Call Time: Units Dispatched: En-route: Arrive Scene:

Arrive Patient: Termination: Incident #:

Incident Location:

Demographic Information

Medical Information Chief Complaint: Secondary Complaint:

PMHx: Allergies:

Meds:

Onset: Sudden Provocation:

Quality: Radiation: Severity: Time:

Vital Signs Time BP HR RR SpO2 BGL Skin Pupils EKG

O2/Airway Medication Time Procedure O2 ETT S/U By Time Name Dose Route Response By

Narrative

EMT/EMR Tech: ______________________________ Reviewed By: ____________________________

Last Name: First Name: M.I: Male Female DOB: Age: Military Civilian Rank: CIV Unit:

Address:

City : State: Zip Code:

File details come from the government source that posted it. Updated .